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1 There are many treatments to erase skin imperfections and reverse the signs of aging. There are creams you can apply and for dramatic results, there are deep chemical peels, laser and dermabrasion. But none has provided the dramatic improvement with low risk and no downtime till the latest breakthrough in cosmetic dermatology Intense Pulsed Light (IPL). It is a highly concentrated light that can treat a range of skin conditions safely and effectively. What Can IPL Do? Smooth Away Wrinkles IPL is an excellent multi-tasker as it improves several conditions when it is applied. It stimulates collagen and restores your skin to its youthful firmness and glow. Close Facial Pores By stimulating production of collagen, IPL virtually eliminates all unsightly pores. Erase Pigmentation IPL disperses melanin that causes age spots and sun pigmentation to fade gradually over several treatments. The same treatment can be used effectively on the neck, chest and hands. Treat Inflamed Skin for Clear and Smooth Skin Facial inflammation, acne or uneven complexion caused by an overabundance of small blood vessels just under the skin can be also be reduced by IPL. How is IPL Performed? A cold gel is first applied to the area to be treated. Your specialist will then place the IPL handpiece gently against your skin and beam pulses of light onto it. You may feel a slight sting. An anaesthetic cream may be applied but for most patients, it is not necessary. The treatment takes about 20 minutes. You may apply make up after you have cleaned up and go straight back to work. No one will notice you have gone for a treatment unless you tell them! Depending on severity and the number of conditions you wish to treat, a series of five to six treatments may be recommended. For more information or to make an appointment, please call our 24 Hour Specialist Appointments Hotline Tel: (65) or Raffles Healthnews Issue 3/2002 9

2 Health & U Osteoporosis: What is Osteoporosis? How does it Happen? We build bones to a maximum bone density up to age of 30 years. Thereafter, we start to lose bone at a very slow rate. At the time of menopause for women, the rate of bone loss suddenly accelerates due to the fall in oestrogen levels. It is this exponential increase in bone loss after menopause that lowers the bone density to fracture-prone levels. As one ages, hormonal changes affect bone deposition and calcium absorption from the gut resulting in accelerated bone loss. This means that elderly persons will be prone to osteoporosis. Hence osteoporosis is called a geriatric disease with adolescent onset. How Big is the Problem? If we were to measure the bone density of all white women over the age of 40, we will find that 26% to 32% of them will have brittle bones at the spine, hip or forearm. It is estimated that in a lifetime, a woman will have a 17.5% chance of fracturing a hip and a 15.6% chance of fracturing the spine (versus 6% for the hip and 5.6% for the spine in a man). In 1990, about 400,000 Asian women suffered from hip fractures. It is estimated that by 2025 the number will balloon up to 1.2 million Asian women. With the increasing number of older people especially in Asia, it is predicted that by 2050, about 51.1% of hip fractures will occur in Asia alone. Apart from the pain and problems with walking that result from hip fractures, it causes a serious economic burden on society. It is estimated that in Singapore, the annual cost of treating hip fractures amounts to $5.8 million. Are You At Risk? Osteoporosis is a disease of the bones that makes it fragile and prone to fractures. It results when the rate of bone loss exceeds the rate of bone formation resulting in a net loss of bone. It is a silent disease that creeps up on the unsuspecting individual and does not announce itself until a fracture occurs. The only way to contain the problem is to identify it whilst it is still early and start preventive measures against fractures. By Dr Teo Sek Khee Who s at Risk? 1. Personal history of a previous fracture as an adult 2. History of fracture in a first degree relative (especially maternal) 3. Current cigarette smoking 4. Alcohol abuse 5. Early menopause (<45 years) or absence of periods (> 1 year) 6. Drugs eg steroids, anticonvulsants, thyroid medications 7. Concomitant illnesses eg hyperthyroidism, hyperparathyroidism, hypogonadism, rheumatoid arthritis, chronic obstructive lung disease, malabsorption 8. Prolonged immobilisation 9. Low calcium intake and low physical activity Which Bones Fracture? Osteoporotic fractures commonly affect the wrist, hip and spine or what are commonly known as fragility fractures. Fractures of the hip and wrist are usually associated with a fall but fractures of the spine can often occur even after an innocuous sneeze or cough. How do Fractures Affect You? Apart from the pain of the fracture, osteoporosis can gradually result in humping of the spine or what is called the dowager s hump. This can distort the chest cavity and impair breathing. The protuberant abdomen that results from this deformity also creates an image problem and necessitates a change of wardrobe. It is estimated that up to 72% of hip fracture patients require some form of walking aid or never walk again. Do I Need to be Screened? There is a simple tool that has been developed for screening Asian postmenopausal women, the Osteoporosis Self-Assessment Tool for Asians (OSTA). Applying the tool (refer to Table 1), if you fall into the high risk category, bone density measurement is recommended; if you fall into the moderate risk category, see your doctor for risk factor evaluation and a bone density measurement is also recommended if these are present. If any person has risk factors that are listed above, a bone density measurement is recommended. Table 1: Osteoporosis Self-Assessment Tool for Asians (OSTA) Age (yr) Weight (kg) Low Risk Moderate Risk High Risk (Copyright 2001, Merck & Co. Inc., Whitehouse Station, NJ, USA. All rights reserved. Reproduced with permission.) What are the Screening Procedures? Simple X-rays are not sensitive enough to diagnose early osteoporosis. There are many touted ways of measuring bone density but the most widely available and accepted way is by dual X-ray absorptiometry (DEXA) of the hip and spine. Other techniques such as ultrasound of the heel/tibia, single energy X-ray absorptiometry of quantitative CT scan do not correlate well and have not been as well validated as DEXA. Bone turnover markers such as urinary pyridinium cross links can be used to follow up patients who are on treatment for osteoporosis. OSTEOPOROSIS SCREENING Package includes: Bone Density Assessment Report by the Radiologist Review of Results by Our Doctor For more information, please call Health & U How Can I Prevent Osteoporosis? Lifestyle changes made early in life can have great impact on preserving bone density eg avoid smoking or excessive consumption of alcohol or caffeine. It has been found in a local nutritional survey that the calcium intake of the average Singaporean is less than 500 mg/day for 62% of all Singaporean adults. Calcium rich foods include dairy products, ikan bilis, sardines, broccoli, spinach, kailan, soya bean products and lentils. The recommended minimum total intake of calcium and vitamin D are as follows : Category Calcium Vitamin D Male years old 1000 mg 400 iu Female years old 800 mg 400 iu All adults years old 700 mg 400 iu All adults > 65 years old 700 mg 800 iu Lactating women 1200 mg 400 iu Regular weight bearing exercises such as walking, jogging, step exercise and weights will help to build bone mass. However, excessive exercise to the point of inducing cessation of menses will actually be detrimental to your bones. A structured exercise programme for the frail elderly will also go a long way to improve postural stability and muscle strength to prevent falls. Fall prevention is an important factor for the elderly. Home environment should not be cluttered with furniture, stray telephone lines or rugs; use of non-slip mats and shoes with non-slip soles will help. Good lighting especially at the stairs is important too. The frail elderly will also benefit from a thorough assessment by a geriatrician to detect illness in the elderly before it results in falls and fractures. If you are on long term medications it would be a good idea to discuss with your doctor if they may cause a harmful effect on your bones. If you are going through menopause, hormone replacement therapy has been shown to prevent osteoporosis as well as lessen the symptoms of menopause such as flushing, sweats and headaches. However there may be a small risk of breast cancer and venous thrombosis and this issue should be discussed with your doctor. Is there Any Treatment for Established Osteoporosis? Once osteoporosis has been diagnosed, there are various treatment options. Bisphosphonates (eg alendronate, risedronate) have been proven to reduce both spine and hip fractures. Hormone replacement therapy can also be used. Raloxifene which is a selective estrogen receptor modulator (SERM) has also been shown to reduce spine fractures and increase bone density. Parathyroid injections have recently been found to be effective. Other alternatives include calcitriol, alphacalcidol and calcitonin. The choice of drugs depends on your profile and your doctor would be the best person to discuss this with you. 2 Raffles Healthnews Issue 3/2002 *Price excludes 3% GST. Raffles Healthnews Issue 3/2002 3

3 Corporate Scene Raffles Women s Centre... Expands to Meet Women s Needs Having A Raffles Baby Our patients are able to select from our range Corporate Scene of beautifully appointed patient rooms for their stay after delivery. All the rooms are designed and outfitted with hotel standards of comfort and furnishings. As a service to our Raffles mothers, bathing of newborn babies is taught in the privacy of the patient s own room on a one-to-one basis. Just one year after its opening in Raffles Hospital, the Raffles Women s Centre has outgrown the clinic on Level 2. In response to growing demand, the centre has moved to expanded premises on Level 12. Should the babies need readmission for phototherapy to treat jaundice, parents may check into our studio rooms located next to the nursery to be close to their babies during treatment. This is a unique service well received by parents. Raffles Women s Centre is our one-stop specialist clinic dedicated to all aspects of women s health. Staffed by our team of full-time O&G specialists, the Centre provides medical care for all matters related to conception, fertility, gynaecology, and women s wellness. Another milestone for the O&G practice in RMG was the delivery of the first Raffles baby a baby girl named Foo Xing Yin by Dr Joan Thong Pao Wen on 19 July The first pair of twins was delivered soon after. O&G Roots Raffles Women s Centre s roots dated back to February 1991 when RMG set up its Obstetrics and Gynaecology (O&G) practice with Dr Joan Thong Pao Wen as its pioneer O&G specialist. The O&G practice, the first specialist medical practice set up in RMG, moved in 1993 to Raffles SurgiCentre. With increasing workload, RMG recruited more O&G specialists and opened the Tampines O&G clinic. In 1997, Dr Koh Gim Hwee joined as our second full-time specialist, followed by Dr Lee I-Wuen in 2000 who brought in expertise in gynae oncology. In December 2001, Dr Tan Yew Ghee merged his successful private practice with RMG. He brought in 3-D ultrasound services. New Raffles Women s Centre The new and expanded premises of Raffles Women s Centre boasts of an interior décor that is elegant and homely, with all the conveniences and amenities from magazines to Within these new premises, the O&G practice offers a wide range of services in Prenatal Diagnosis and Fetal Maternal Medicine Reproductive Medicine Gynaecological Minimally Invasive Surgery Gynaecological Oncology Menopausal Medicine Uro-Gynaecology Well Women Programmes Our maternity suites provide generous space and a comfortable ambience for both parents to prepare for baby s arrival. The delivery rooms are set up with state-of-the-art equipment including telemetric CTG monitoring for patients who wish to have walking epidurals. Full neonatal intensive care facilities are also available for management of premature babies. Competitive Packages for Maternity Service Maternity Packages covering antenatal care to post-partum exercise Delivery Packages for normal delivery, assisted delivery or caesarean section children s play corner to drink dispenser that brews from coffee to teh tarik. For more information or to make an appointment, please call For a tour of our Maternity Ward, please call Raffles Healthnews Issue 3/2002 Raffles Healthnews Issue 3/2002 5

5 Look Good & Feel Good ACNE Medical Myths By Dr Bina Kurup Acne is mainly a hormonal problem which results in overactive oil glands. These oil glands sometimes get blocked by dead skin cells and gets infected. Hence the mainstay of acne treatment is usually regular facial cleansing, antibiotic treatment and local therapy to clear blocked pores. Myths only affects teenagers Facts Though acne tends to be more pronounced during the pubertal years, it can also occur at other times of a person s life. Stress seems to be an important trigger of acne. Drugs such as hormone pills, steroid and certain anti-epileptic medication can also cause acne. can be aggravated by chocolates long-term antibiotic use has major side-effects There is usually no association between the intake of sugar and chocolates with acne. No studies so far has linked dietary factors with acne. Patients tend to worry about problems of side-effects, toxicity and resistance. These have shown to be minimal with the antibiotics currently used. To minimise potential problems in selected patients, topical (or locally applied on skin) antibiotics are also available. HAIR LOSS Hair is an important element of overall external looks. Millions of dollars are spent on hair products or medicines to promote hair growth. Myths frequent shampooing contributes to hair loss shaving head bald will cause hair to grow back thicker dandruff and stress cause permanent hair loss standing on one s head improves circulation to the scalp and increases hair growth hair loss affects only intellectuals Facts It is normal that between 100 to 150 strands of hair is lost every day. If the balding is obvious, there are several causes, the commonest of which is hormonal (either male-pattern or female-pattern) Stress (such as high fever, major illness or operation or childbirth) can cause hair loss but this is usually reversible. OBESITY Obesity is an increasing health problem in Singapore and other developed countries. This problem is becoming increasingly evident, especially among school children. Weight is easily gained when the calorie intake exceeds the output (i.e. calories burnt). The most sensible (and long-term) way to keep the weight down to the ideal for the individual, is to reduce the intake (by reducing calorie intake from fats and carbohydrates) and increase output by regular exercises. Obesity can cause life long health problems, and in particular, increases the risk of heart disease and stroke. Myths I ll eat what I want...then I ll just take these fat burners and I won t put on any extra weight Laxatives (to increase bowel movement) and diuretics (to increase urine output) will make me lose weight fast. They also help me to remove toxins from my body. Facts Slimming pills often have a temporary effect, and when stopped, may increase the weight back to its original again. They often have side-effects and should be use judiciously in consultation with your family doctor. Overuse of laxatives and diuretics as a weight control pill can in fact be dangerous because of the electrolyte imbalance they can cause. This in turn has harmful effects on the heart and cells of the body. Here s to Good Health and Good Looks! Raffles Healthnews Issue 3/2002 7